Focus:  Sun Safety
As you all know, we are strong sun safety advocates here at BVCD. While studies old and new confirm that over exposure to UV rays causes dangerous cell damage, the rising incidence of skin cancer makes us more determined to get the word out on sun safety. In this edition of Skin Deep, we share several recent media features with Dr. Gallagher and Dr. Leddon discussing sun exposure, and solutions to keep your skin healthy and looking its best.

Good Day Colorado
There are many lines of defense to protect against skin cancers and keep your skin looking its best. Check out this recent Good Day Colorado segment featuring Dr. Leddon to learn more about some unique UV protective products we like.

Is Tanning Addictive?
Most people who tan are actually well aware that exposure to ultraviolet rays can cause skin cancer. Why do they go out of their way for more and more sun exposure? Some studies suggest that tanning is actually addictive. Dr. Gallagher discusses repetitive tanning in this Boulder Daily Camera story.

Convincing Teenagers
When it comes to sun safety, teenagers are often the most difficult group to convince. We like this short and compelling article from Teen Vogue, which features Dr. Leddon.

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Sara Angel looked around the pool party. Teenagers and twentysomethings in swimming suits stretched out under the sun. Most didn’t bother with sunscreen.

Including 23-year-old Angel.

Despite the fact that she works at a Boulder dermatology office.

“I looked around and thought, ‘This is horrible, my doctor’s worst nightmare,’” she says. “I know it’s bad. But to some extent, I like it. You lay out. You’re relaxed, not caring.”

She admits it’s a double-standard, working with a dermatologist during the week and lying out in the sun on the weekends. About once a month, she hits up a tanning bed. She thinks her skin looks better tan.

Even her hair does, she says.

She knows UV rays cause cancer; who doesn’t these days? But compared to her friends — one who tans indoors as often as five days a week — Angel doesn’t think she has a problem.

For some people, tanning isn’t just a dangerous habit. It’s a true addiction, according to a study recently released in the Archives of Dermatology. Some advocates have begun putting it in the same category as cigarette smoking.

First came the American Cancer Society’s recent classification of UV rays as a carcinogen — a known cause of cancer.

Now, the study of 421 college students in New York found that nearly half had tanned at a tanning salon. Of these, as many as 40 percent met criteria for tanning addiction.

More than two-thirds of the tanning addicts were women.

These students also reported greater symptoms of anxiety and were more likely to use alcohol and marijuana, the study found.

“I think this is the beginning of the tanning story right now,” says Casey Gallagher, with the Boulder Valley Center for Dermatology. “The medical outcry against tanning is in its early stages, the last five years, as opposed to 40 or more years for smoking.”

In the tanning study, researchers used similar questions from alcoholic-screening tests: Do you feel the need to cut back? Do you feel angry or annoyed when people ask you about your tanning? Do you feel guilty? Do you wake up thinking about tanning?

“If the answer is yes to any of these questions, it’s concerning,” Gallagher says.

Historically, tan skin was considered unattractive. It was associated with the working class, who spent time outside. But today, it is associated with travel — with wealth and pleasure — “being able to take time off and get sun outside,” Gallagher says. “There are social pressures to be tan. It’s considered attractive and healthy-looking.”

Those social pressures are even worse in an outdoor mecca like Boulder County, he says.

“You’re living the dream in Boulder County if you have a tan, because you’re outside hiking or climbing,” Gallagher says.

He sees patients in his Boulder office every month who know tanning causes cancer but continue to do it. One man in his 30s has pre-cancerous markings on his face, and has visited Gallagher multiple times swearing he is going to stop going to the tanning salon.

“He can’t quit,” Gallagher says.

In fact, studies show the tanning salon business is growing, despite the American Cancer Society’s warnings.

Some people, like Angel, say tanning makes them feel good.

“I fall asleep almost every time,” she says, talking about tanning beds. “You have the music on, your eyes closed. It’s kind of meditative.”

Tanning feels good — literally. UV rays can cause your body to release endorphins, which provide a soothing sensation. The immediate gratification can make it difficult to balance against the long-term risk of disease.

Gallagher says some people might need psychological support, medication and group therapy to kick the habit. Except if you Google “stop tanning” and “Boulder,” there are no support resources. Only a link to a “one-stop tanning body shop.”

Lafayette esthetician Jamie Gordon says she has convinced many of her clients to stop using tanning beds. In fact, she says, she was instrumental in getting tanning beds removed from Boulder’s Rally Sport Health and Fitness Club, and she used to teach “Safe Sun” classes there and at Fairview High School.

“I think it may be similar to people with addictions to plastic surgery,” she says. “Once you get started, it may be hard to quit.”

Safe sun

For people who still desire a beach bronze, spray tans and self-tanners are a safer alternative.

Boulder-based VerandaSun boasts a custom airbrush tanning application. The solution is natural and doesn’t contain alcohol, oils, perfumes, chemicals or preservatives.

“There is no denying, we all look better with a tan,” VerandaSun’s Web site says. “Just not with the cumulative anti-aging effects of the sun (or the orange palms that result from self tanners).”

Boulder stylist Marian Rothschild recommends a mineral-based bronzer on the face and self-tanner on the legs.

Although no self-tanners are all-natural or organic — a chemical reaction needs to occur for the skin to turn golden — Rothschild recommends low-odor tanners at Sephora at the Twenty Ninth Street Mall, such as A Tan for All Seasons by Bliss or a no-streak formula by The Kardashians.

Louisville-based MyChelle Dermaceuticals makes a sunless tanner without toxic chemicals that some sunless tanners contain. The Del Sol Bronzer contains organic aloe and organic essential oils.

Despite the alternatives, some people still prefer the sun. Rothschild says her neighbor has had two lumps removed from his face, but he still tries to get as dark as possible ever summer. No hat or sunscreen.

“In fact, he’s already very tan from just being outside for many hours this past weekend,” Rothschild says. “Some people just don’t learn.”

Contact Staff Writer Aimee Heckel at 303-473-1359 or heckela@dailycamera.com.

1. How does Botox work?
Botox works by relaxing facial muscles that cause wrinkles. It is especially effective at treating wrinkles on the forehead, “frown lines” in the area between the eyebrows, and crow’s feet.

2. Will I still be able to make facial expressions?
Absolutely. There has been a lot of exaggeration in movies and on television (mostly for comedic effect) about the extent of musle relaxation. You will see a softening of expression, but you should not have any problem expressing yourself.

3. Do Botox injections hurt?
There may be minimal pain with injection, but it is temporary. Some people compare the pain to a mosquito bite; others state they feel no pain. If you are concerned about pain, icing the treatment site(s) in our office immediately before the injections may decrease the pain.

4. When will I see results?
Most patients see effects within 4-7 days of treatment with Botox. In most people, the medicine’s effect continues to improve over the first month.

5. How long do the results last?
Typically, the results from Botox last 3-4 months. Patients often state that with repeated treatments, Botox lasts longer, but this may vary on a case-by-case basis.

More Comfortable Fillers
An exciting new Restylane® and Perlane® treatment innovation is now available here at Boulder Valley Center for Dermatology. New Restylane-L™ and Perlane-L™ both contain lidocaine to help provide a more comfortable experience. If you want a more youthful appearance, but you’ve been concerned about the potential discomfort, now you can get a smoother look with a more comfortable experience. Call our office today for a consultation to learn more.

New Evening Hours
To better serve you, we now offer evening appointments at our Boulder offices. New office hours are noon – 7 p.m.

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Top beauty professionals reveal what they do to keep their own skin looking healthy and vibrant, from eye-cream applications to regular use of injectables. And they share low-cost beauty solutions and the biggest beauty blunders women commit.

Allergic Contact Dermatitis
Don’t ignore a mystery rash.  You could have Allergic Contact Dermatitis, your skin’s way of telling you it doesn’t like something in your environment. Identifying that particular something – or more specifically, what you’re allergic to – is essential for bringing your skin back to good health.

Irritants like acid, alkali and strong detergents can trigger a rash for anyone, so always avoid them. On the other hand, allergens may provoke a specific rash response to an unsuspected, everyday substance.

Once your skin reacts negatively to something – whether it’s jewelry, cosmetics, rubber, latex, or plants – you are officially allergic to an element of that item. Redness, swelling and blistering are common clues.

But because you come into contact with different kinds of elements in various forms every day, you may need a patch test to identify the specific allergen.

That’s where we come in. At BVCD, we offer The North American Contact Dermatitis patch test, which is very comprehensive, testing 65 common allergens (as opposed to conventional patch tests, which target only 25). Also, we can test for combinations of allergens, based on your situation.

This means we can identify what you’re allergic to more precisely and treat your skin more appropriately. We can advise you on how to avoid the offending substance, and materials that may cross-react with it. And when appropriate, we can recommend good substitute products that won’t cause reactions.

If continuously exposed, an allergic rash will go from bad to worse, making skin appear dark, leathery and cracked. The sooner you seek help the better. Call our offices any time to schedule an appointment at (303) 604-1444.

Common Allergens
The US Food and Drug Administration maintains this helpful website on product and ingredient safety. 

• Nickel in jewelry, clasps or buttons.
• Balsam of Peru, a fragrance found in perfumes and lotions.
• Chromium, used in the tanning process for leather products.
• Thimerosal, a mercury compound used in local antiseptics and vaccines.
• Neomycin, a topical antibiotic.
• Fragrance Mix, a group of the eight most common fragrance allergens.
• Formaldehyde, a preservative found in paper products, paints, medications, cleaners, cosmetics and fabrics.
• Cobalt Chloride, a metal found in medical products, hair dyes, antiperspirants and metal-plated objects.
• Bacitracin, a topical antibiotic.
• Colophony, a rosin, sap or sawdust typically from spruce or fir trees.
• Topical steroids.         

Microdermabrasion
Microdermabrasion is a safe, painless and highly effective way to restore a clear, youthful glow to the skin. The procedure sloughs off dead and dull surface layers of the skin, stimulating an increase in collagen production and rejuvenation. Many patients see dramatic improvements in the tone, texture and color of treated areas after just one treatment. It also can improve:

• Oily or dull skin
• Enlarged or clogged pores
• Fine lines
• Mild acne scars
• Mild complexion problems

Book a lunchtime appointment. It takes only about 45 minutes!

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About this time of year I begin to itch – a lot. And I have trouble sleeping because my throat becomes so dry at night that it’s almost painful. I compulsively apply chapstick to my lips and slather cream on my hands. Winter is so drying, especially here in Colorado that I feel like a big scarecrow sometimes. And when you turn on your heating system, it sucks even more moisture out of the air.  But there are ways to combat this drying winter weather that really work, if you follow them.

• One of the first things I do when I start feeling dry is break out my humidifier. I swear this solved my sleep problem immediately but it has a multitude of benefits with regards to dry skin. Riley Greene, M.D., of the Denver Skin Clinic says that a humidifier won’t only help you feel better; it will make you look better too. “When the skin dries, wrinkles appear more prominent,” says Greene. “If your skin is hydrated, it will look plumper and hide the wrinkles.” But many people are confused as to what type of humidifier to buy: warm mist, cold mist, big, small, etc.  
• Change your daily body and hand moisturizer to an ointment or crème, says Casey Gallagher, MD of the Boulder Valley Center for Dermatology. “You want to use something that you can squeeze from a tube or scoop out of a jar,” Dr. Gallagher explains. For your face, an ointment or crème might be too heavy during the day so a regular lotion will be Ok but just make sure it has sun protection. At night, be sure to use something thick and heavy—even a simple slather of Vaseline or Aquafor will do the trick.
• Cut down on hot showers and baths. According toWebMD, the “intense heat of a hot shower or bath actually breaks down the lipid barriers in the skin, which can lead to a loss of moisture.”  They recommend taking a lukewarm bath oatmeal or baking soda. I’m going to admit right now that although I trust this advice is true, it’s not something that I could do. I love my hot showers and am willing to suffer the consequences rather than give them up. Fortunately, Dr. Gallagher says if you simply make them shorter, then you should be fine. He adds that you should use a non-drying soap and be sure to slather on body crème or ointment within minutes after your shower or bath to lock in the moisture.

Lip protection is essential in the winter. Nothing is more uncomfortable or less kissable than dry chapped lips. Access Hollywood offers these tips to save your lips:

1. Use a wet (wrung out) washcloth to vigorously “buff” the lip area. This provides just the right amount of exfoliation and removes dead dry skin, leaving behind a smooth surface.
2. Rub everything you use on your face all over your lips – and be generous. This means moisturizers, Retin-A, AHA’s, etc.
3. Finish with a sealant. Use something that is thick and emollient. This idea is to leave behind a barrier that sits on your lips throughout the night and prevents moisture from escaping. Some great examples are plain old Vaseline or Elizabeth Arden’s Eight Hour cream.
4. In the morning, make certain you again massage your facial products onto your lips and you won’t believe how silky, plump and smooth they will look. Say goodbye to those undesirable dry, chapped lips!

By Lisa Fields
Reviewed by Louise Chang, MD

Is your beauty routine safe when you’re pregnant? Get insights on what changes you may want to consider.

You swore off cocktails and stopped eating sushi when you found out you’re pregnant, but you hadn’t considered the safety of your beauty products until you accidentally inhaled some hair spray this morning. Now you’re wondering if you should change some of your beauty habits for the rest of your pregnancy. Maybe you’re not inclined to go au naturel; but you want to do what’s best for the baby. You’re just not sure what that is.

“Any material placed on the skin has the potential to be absorbed into the bloodstream and may be able to cross the placenta, so some caution is warranted,” says Andrew Healy, MD, an obstetrician at Baystate Medical Center in Springfield, Mass. “However, very few substances are suspected or have been proven to be harmful to a developing pregnancy.”

If you’re unsure what’s safe, bring specific products to your doctor for analysis, recommends John Bailey, PhD, chief scientist for the Personal Care Products Council, a trade group for the cosmetic and personal care products industry.

“At the most fundamental level, women should consult their physicians for medical advice and to discuss any concerns they may have,” Bailey says.

What’s safe during pregnancy? What should be avoided? Here’s what doctors told WebMD.

Teeth Whiteners

Worrisome ingredient: Peroxide

Concerned? Try peroxide-free whitening toothpaste.

She still smiles as much as ever, but Monica Thomas of Akron, Ohio, thinks her teeth look dull. That’s because Thomas, who’s expecting her fourth child in February, stopped using tooth-whitening strips.

“I felt I could survive 40 weeks without them,” she says. “I’ll start again after I stop nursing.”

The active ingredient, peroxide, is safe for adults, even if you swallow some during the bleaching process, says Colleen Olitsky, DMD, a cosmetic dentist in Ponte Vedra Beach, Fla. “But there’s so much we don’t know about how substances affect babies during pregnancy, it’s wise to avoid.”

“Ingesting some peroxide is probably safe for pregnant women, but if you’re concerned, use a whitening toothpaste instead,” says Dayna Salasche, MD, clinical instructor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine in Chicago. “Most importantly, continue to brush, floss, and see the dentist regularly for cleanings.”

Hairspray, Nail Polish

Worrisome ingredient: Phthalates

Concerned? Try mousse or gel, which can’t be inhaled, or phthalate-free polish.

A growing body of research suggests a possible link between phthalates (found in many products including hair spray and nail polish) and increased risk of birth defects. But the FDA concluded that the available data don’t establish an association between the use of phthalates in cosmetics and a human health risk.

“It’s all a matter of amount used,” says Judith Hellman, MD, associate clinical professor of dermatology at Mount Sinai School of Medicine in New York. “A small amount of spray, applied without breathing in the fumes, is probably acceptable.”

Is your beauty routine safe when you’re pregnant? Get insights on what changes you may want to consider.

If you’re repeatedly exposed to hair spray at work, though, your baby may have an increased risk of birth defects. A recent British study showed that baby boys born to such women were two to three times more likely to have a a birth defect of the penis, although that study, published in Environmental Health Perspectives in 2008, didn’t prove that hair spray was to blame.

When using nail polish, apply in a well-ventilated area to limit exposure. Once the polish dries, there’s little risk to your baby, since chemicals aren’t absorbed through the nails.

“Phthalates have not been connected to birth defects in humans,” Healy says. “However, studies in animals have shown these substances to interfere with male sexual development, so caution is warranted.”

Sunscreen and Self-Tanner

Worrisome ingredient: Oxybenzone

Concerned? Try sunscreen with zinc oxide or titanium dioxide.      

You want protection from the sun’s rays but aren’t sure if you should rub chemicals into your skin daily throughout pregnancy. One recent study linked the absorption of oxybenzone, a sunscreen ingredient, to low birth weight in baby girls. But that research doesn’t prove that the sunscreen was to blame. And there are other options. Many sunscreens contain zinc oxide and titanium dioxide, which block UV rays by sitting atop the skin.

Feeling pale? Self-tanners haven’t been studied much in pregnant women. “An occasional self-tanner will do a lot less harm than a real tan or tanning beds,” Hellman says. “But for nine months, you can survive without looking bronzed.” 

“Sunscreen is extremely important because pregnancy hormones can make the skin more sensitive than normal,” Salasche says. “It’s best to use products that block the sun without being absorbed and wear a hat and other protective clothing.”

Acne Medication

Worrisome ingredients: Salicylic acid, benzoyl peroxide, retinol, retinoid

Concerned? Try glycolic peels.

Acne often worsens during pregnancy because of hormone fluctuations. But don’t use your usual pimple cream if it contains retinol, benzoyl peroxide, or salicylic acid. Prescription retinoid products should also not be used.

Talk to your doctor if you’re breaking out. “I prescribe topical medications that contain azelaic acid, erythromycin or clindamycin,” says Jeanie Leddon, MD, PhD, a dermatologist in Lafayette, Colo. “Glycolic acid peels are also safe.”

“Salicylic acid has been associated with an increased risk for miscarriage when used in the first trimester,” Healy says.  

Hair Dye

Worrisome ingredients: Ammonia, peroxide

Concerned? Try highlights instead.  

“Gray roots would have exposed my pregnancy at work before I was ready to tell people,” says Mara Palcisco of Wilmington, N.C., who’s expecting her second child in January. “So I kept dyeing my hair, even during the first trimester.” 

Researchers haven’t examined the effects of hair dye on pregnant women, so some doctors recommend avoidance. “Dyes contain a variety of ingredients that, when ingested, fall into the poisonous category, so the rule of thumb is to avoid hair color during pregnancy,” says New York dermatologist Jeannette Graf, MD. “Highlights that aren’t applied to the scalp may be fine.”  

Other physicians are more lenient. “It’s thought that only a small amount of hair-treatment chemicals are absorbed into women’s skin, and this isn’t enough to cause problems to the fetus,” Leddon says. “As a conservative measure, avoid hair treatment for the first trimester, when the developing fetus can be most susceptible. Avoid treatments with ammonia, treat hair in a well-ventilated room, wear gloves, and rinse well immediately after treatment.”

“Hair dye has never been tested, but since it’s used topically, it’s considered safe for use throughout pregnancy,” Salasche says.

Makeup

Worrisome ingredients: lead, fragrance

Concerned? Try lead-free, fragrance-free products.   

Plenty of women apply foundation, lipstick, and other cosmetics first thing in the morning and leave them on until bedtime. But some makeup contains lead and other questionable ingredients.

“Pregnant women should think carefully about what they need to feel comfortable and feminine but try to not use extras,” says Sean Gray, senior analyst at the Environmental Working Group, a nonprofit organization which co-founded the Campaign for Safe Cosmetics.

Lead is sometimes added to lipstick to make color long-lasting. In 2007, the Campaign for Safe Cosmetics found that 61% of brand-name lipsticks they tested contained lead. The FDA doesn’t consider it to be a safety concern, since lipstick isn’t ingested. But if it makes you feel better, there are lead-free lipsticks on the market.  

“The contribution of lead-containing lipsticks [to lead poisoning] is unknown but probably fairly small,” Healy says. “Nevertheless, it would be prudent to utilize lead-free products.”

Anti-Wrinkle Cream, Botox Cosmetic

Worrisome ingredients: retinol, Botox Cosmetic

Concerned? Use moisturizers and sunscreen instead.     

With a trend toward older mothers, pregnant women may reach for wrinkle cream almost as often as stretch-mark lotion. But before massaging it into your laugh lines, consider the ingredients: Many wrinkle creams contain retinol, which has been linked to birth defects.

Some women who seek more youthful appearances get Botox Cosmetic injections to smooth furrowed brows, but experts recommend skipping such treatments during pregnancy.

“There haven’t been any conclusive studies, but the consensus is that it may be related to miscarriage or impaired growth,” Salasche says.

“There are no adequate, well-controlled studies of Botox Cosmetic in pregnant women, so administration of Botox Cosmetic is not recommended during pregnancy,” Kellie Reagan, a spokeswoman for  Allergan, the drug company that makes Botox Cosmetic, states in an email to WebMD.

“If a woman wants to use an anti-wrinkle cream during pregnancy, she should bring the specific product to her physician so that he or she can review the contents,” Healy says.

Our answer? No.

On the one hand, studies have found that by blocking ultraviolet rays, sunscreen does in fact limit the vitamin D we produce. But a preponderance of studies have concluded that this effect is negligible. While sunscreen does hamper vitamin D production, these studies say, it is not enough to cause a deficiency. First off, most people don’t wear enough sunscreen to completely block the sun. More importantly, it doesn’t take much sun to produce adequate amounts of vitamin D. According to the National Institutes of Health, perhaps as little as 30 minutes of daytime exposure (without sunscreen) twice a week is ample to spur adequate vitamin D production.

Based on current available data, The American Academy of Dermatology recommends that you continue to protect your skin from the sun.  It’s one of the most important things you can do to keep and maintain healthy, cancer-free, great looking skin. And remember that Colorado is one of the sunniest places in the entire country, even in winter. Your general exposure to the sun here is more than enough to keep your vitamin D levels where they need to be. If you’re worried, instead of cutting back on sunscreen, increase your consumption of vitamin D rich foods – like salmon, milk and orange juice.

(For more indepth information, the National Institutes of Health web site offers this comprehensive article on vitamin D.)

Best Ways to Fake a Tan
In the last Skin Deep we wrote about new scientific proof that tanning beds cause of skin cancer. Many of you wondered about the best ways to get a tanned look safely. Here’s a terrific blog post on the subject from The Learning Channel’s web site, quoting our own Dr. Gallagher:  Best Ways to Fake a Tan.

Eczema Help
What Is Eczema? Eczema is a term for a general group of conditions that cause the skin to become inflamed, dry, red and itchy.

Causes? Although we do not know the specific cause for eczema, atopic dermatitis is often associated with asthma and hayfever. Scratchy clothing, over bathing, irritating soaps, stress and allergies can exacerbate it.

How Common? The prevalence of the most common form of eczema (atopic dermatitis) is rising and thought to impact 10% – 20% of the population.

Treatments?  While there is no cure, there are many treatment strategies for eczema. Lifestyle choices that keep the skin well hydrated as well as non-irritating clothing are good first steps. Topical medications like over-the-counter treatments  prescription medications with or without steroids, and antihistamines can bring relief as well. In severe cases, phototherapy and systemic medications are warranted. ALL medications, over-the-counter or prescription, can have potential side effects.

Bottom Line?  Seek help from your dermatologist if you or your child has persistent, itchy, recurring rashes. Your dermatologist can safely treat as well as control this potentially life-altering condition.